It’s been almost a week since the Supreme Court’s momentous ruling that further cements the Affordable Care Act as the law of the land, and Wednesday President Barack Obama flew to Nashville, Tennessee, to talk about health care.
While some consider this a bit of a victory lap, the president’s choice of Tennessee suggests it’s much more of an overture.
For those of you not keeping score at home, just 29 states and the District of Columbia have expanded Medicaid, the healthcare program primarily for low-income and disabled people.
The president wants that list to grow.
So how do you convince GOP governors and conservative lawmakers in the wake of the King vs. Burwell decision to do something they’ve sworn to oppose? For years, the Obama administration has made a financial argument.
“When I worked on the Council of Economic Advisers, we did a report and basically demonstrated again and again and again that states would win economically,” says Mark Duggan, now an economist at Stanford University.
That report is from 2009. Since then, study after study has echoed similar themes that go something like this: if Washington picks up nearly the entire tab for expansion, states will see new jobs, budget savings and economic prosperity. With many states still holding out, that argument hasn’t worked on everyone, obviously.
(Courtesy Kaiser Family Foundation)
But until recently those reports have been a bunch of words. Now, the Urban Institute’s Stan Dorn says there are actual results that may grab the budget hawks’ attention.
“Every state that has looked comprehensively at both costs and benefits has found that the state budget is better off than it would have been without expansion,” he says.
Take Arkansas and Kentucky, says Dorn. They’ve expanded Medicaid and stopped spending money elsewhere.
“On mental health programs, Kentucky is saving $21 million this year; Arkansas is saving $7 million this year. On uncompensated care to hospitals. Kentucky is saving $12 million; Arkansas is saving $17 million,” says Dorn.
This is more than pointy heads in Washington running numbers. Even GOP presidential candidate and New Jersey Gov. Chris Christie says “expanding Medicaid was the right decision for New Jersey.”
While the math may be convincing to some, Stanford’s Lanhee Chen doubts it moves many conservative statehouse types who think Medicaid is a broken program.
“The difficulty is Medicaid expenses continue to increase. So some state lawmakers have a legitimate concern around maybe not what the next five years look like, but what the next 10 or 15 years look like,” he says.
Chen believes the path to expand Medicaid is more about politics than economics. His advice to the president: give states more flexibility in designing their own programs and you’ll see states bite.
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